Canadian Community Health Survey (CCHS) : Nutrition - 2015 (First Interview)
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Proxy interview (GR)
- Survey Introduction (INT)
- Age of respondent (ANC)
- Automated Multiple Pass Method (AMPM)
- AMPM Trailing Questions (TRL)
- Proxy interview (GR)
- Nutritional Supplements (First recall) (NSP)
- Nutritional Supplements Detail (NSD)
- General Health (GEN)
- Health Minimum Block (HM)
- Measured Height and Weight (MHW)
- Self-reported Height and Weight (HWT)
- Physical Activity - Short Form (PHS)
- Physical Activity of Children and Youth (CPA)
- Women's Health (WHC)
- Chronic Conditions (CCC)
- Smoking (SMK)
- Socio-Demographic Characteristics (SDC)
- Aboriginal Minimum (AMB)
- Population group (PG)
- Language Minimum (LAN)
- Language Look-up (LLU)
- Selection of Second Recall Respondent (SEL2)
- Education (EDU)
- HC: Education Sublock School attendance "currently" - ESC1
- HC: Education minimum - EDM
- Labour Market Activities Minimal (LMAM)
- Person most knowledgeable about household situation (PMK)
- Food Security (FSC)
- Income (INC)
- Administration (ADM)
- Health Number Validation (HN)
Proxy interview (GR)
Proxy interview (GR) - Question identifier:GR_N01
Select the person who is providing the information for this component. For parent-assisted interviews (for children aged 6 to 11), select the child as the person providing the information.
- 01: MEMBER1
- 02: MEMBER2
- 03: MEMBER3
- 04: MEMBER4
- 05: MEMBER5
- 06: MEMBER6
- 07: MEMBER7
- 08: MEMBER8
- 09: MEMBER9
- 10: MEMBER10
- 11: MEMBER11
- 12: MEMBER12
- 13: MEMBER13
- 14: MEMBER14
- 15: MEMBER15
- 16: MEMBER16
- 17: MEMBER17
- 18: MEMBER18
- 19: MEMBER19
- 20: MEMBER20
Proxy interview (GR) - Question identifier:GR_N02
Do you want to complete this interview by proxy?
- 1: Yes
- 2: No
Proxy interview (GR) - Question identifier:GR_N03
Record the reason why this component is being completed by proxy. Proxy interviews for respondents aged 6 and older are to occur only if the mental or physical health of the selected member makes it impossible to complete the interview during the collection period. If the reason for the proxy interview is neither of these choices, please press <F10> to exit the application and assign an appropriate outcome code.
- 1: Physical health condition
- 2: Mental health condition
Proxy interview (GR) - Question identifier:GR_N04
Enter the condition.
Long Answer Length = 80
Survey Introduction (INT)
Survey Introduction (INT) - Question identifier:INT_R01
This survey collects information on the nutrition of people in Canada. It includes questions on eating habits and other factors that may relate to health and nutritional well-being.
Survey Introduction (INT) - Question identifier:INT_R02
Your answers are collected under the authority of the Statistics Act and will be kept strictly confidential.
Survey Introduction (INT) - Question identifier:INT_R03
Although your participation in this survey is voluntary, your cooperation is important so that the information collected will be as accurate and complete as possible.
Age of respondent (ANC)
Age of respondent (ANC) - Question identifier:ANC_R01
For some of the questions I'll be asking, I need to know your exact date of birth.
Age of respondent (ANC) - Question identifier:ANC_N01A
Enter the day. If necessary, ask (What is the day?)
Min = 1; Max = 31
Age of respondent (ANC) - Question identifier:ANC_N01B
Enter the month. If necessary, ask (What is the month?)
- 01: January
- 02: February
- 03: March
- 04: April
- 05: May
- 06: June
- 07: July
- 08: August
- 09: September
- 10: October
- 11: November
- 12: December
- 98: RF
- 99: DK
Age of respondent (ANC) - Question identifier:ANC_N01C
Enter a four-digit year.
If necessary, ask (What is the year?)
Min = 1893; Max = 2014
Age of respondent (ANC) - Question identifier:ANC_Q02
So your age is ^DVAGE.
Is that correct?
- 1: Yes
- 2: No, return and correct date of birth
- 3: No, collect age
Age of respondent (ANC) - Question identifier:ANC_Q03
What is your age?
Min = 0; Max = 121
Age of respondent (ANC) - Question identifier:ANC_R04
Because you are less than 1 year old, you are not eligible to participate in the Canadian Community Health Survey.
Automated Multiple Pass Method (AMPM)
Automated Multiple Pass Method (AMPM) - Question identifier:AMPM_R1
The 24-Hour Dietary Recall interview is composed of 5 Steps:
1.Quick List: The Quick List step is designed to get a quick collection of easily remembered foods, including snacks and water. In this step, respondent reports a listing of all foods and beverages consumed in a 24-hour period during the day before the interview in any order he/she wishes (without being interrupted by the interviewer). That is, the respondent is free of the burden of reporting the foods in a chronological order, so his/her mind can be free to reflect on the foods actually eaten.
Automated Multiple Pass Method (AMPM) - Question identifier:AMPM_R2
2. Forgotten Foods: This step is designed to collect foods that may have been forgotten during the "Quick List" step. The respondent answers a series of questions probing for forgotten foods from various categories: non-alcoholic beverages, alcoholic beverages, sweets, savoury snacks, fruits, vegetables, cheese, breads and rolls, and any other types of foods.
Automated Multiple Pass Method (AMPM) - Question identifier:AMPM_R3
3. Time and Occasion: The respondent reports the time he/she began eating or drinking each of the reported foods and what he/she would call the eating occasion (e.g. breakfast, lunch) - as defined by the respondent - for this food. These questions are designed to help the respondent remember and report his/her eating patterns over the 24-hour period of the previous day, as well as to group together the foods eaten at the same time.
Automated Multiple Pass Method (AMPM) - Question identifier:AMPM_R4
4. Detail Cycle: This step is reserved for more detail oriented questions, executed by the interviewer after having developed a rapport. Respondent answers standardized questions to probe for detailed information about each food and beverage reported in the Quick List step. The questions include probes for: food descriptions, food amounts, additions to the foods, and preparation methods.
A "Food Model Booklet" is used as the main measuring guide to help the respondent describe the size or amount of the food consumed. The booklet contains pictures of various sizes of glasses, mugs, bowls, mounds/pats/spreads, and circles. In addition, it includes a grid, two wedges, and a page of shapes and chicken pieces.
Reviews of eating occasions and times between occasions are also included in this step to elicit forgotten foods. Once information about the eating occasion is complete, then the respondent is asked where the meal was eaten. The application flows in a chronological order.
Automated Multiple Pass Method (AMPM) - Question identifier:AMPM_R5
5. Final Probe: A final probe is asked to collect additional foods that may have been consumed, but not remembered or mentioned earlier during the interview.
AMPM Trailing Questions (TRL)
AMPM Trailing Questions (TRL) - Question identifier:TRL_Q01
Now I'll be asking some questions about your use of table salt.
What type of salt do you usually add to your food at the table? Would you say it is ordinary salt, seasoned salt, sea salt, half salt or a salt substitute?
- 1: Ordinary salt
- 2: Seasoned or other flavoured salt
- 3: Sea salt or gourmet salt
- 4: Half salt or lite salt
- 5: Salt substitute
- 6: None
- 8: RF
- 9: DK
AMPM Trailing Questions (TRL) - Question identifier:TRL_Q02
How often do you add TRL_Q01 to your food at the table? Is it rarely, occasionally or very often?
- 1: Rarely
- 2: Occasionally
- 3: Very often
- 8: RF
- 9: DK
AMPM Trailing Questions (TRL) - Question identifier:TRL_Q03
How often is ordinary salt added in cooking or preparing foods in your household? Is it rarely, occasionally, very often, or never?
- 1: Rarely
- 2: Occasionally
- 3: Very often
- 4: Never
- 8: RF
- 9: DK
AMPM Trailing Questions (TRL) - Question identifier:TRL_Q04
Do you completely exclude any of the following foods from your diet? By 'completely exclude', we mean you never eat it on its own, or as part of a prepared dish.
- 1: Meat (beef, pork, lamb, etc.)
- 2: Poultry (chicken, turkey, duck, etc.)
- 3: Fish and shellfish
- 4: Eggs
- 5: Dairy products (milk, cheese, etc.)
- 6: Gluten sources (wheat, barley, rye, triticale, etc.)
- 7: None
- 8: RF
- 9: DK
Proxy interview (GR)
Proxy interview (GR) - Question identifier:GR_N01
Select the person who is providing the information for this component. For parent-assisted interviews (for children aged 6 to 11), select the child as the person providing the information.
- 01: MEMBER1
- 02: MEMBER2
- 03: MEMBER3
- 04: MEMBER4
- 05: MEMBER5
- 06: MEMBER6
- 07: MEMBER7
- 08: MEMBER8
- 09: MEMBER9
- 10: MEMBER10
- 11: MEMBER11
- 12: MEMBER12
- 13: MEMBER13
- 14: MEMBER14
- 15: MEMBER15
- 16: MEMBER16
- 17: MEMBER17
- 18: MEMBER18
- 19: MEMBER19
- 20: MEMBER20
Proxy interview (GR) - Question identifier:GR_N02
Do you want to complete this interview by proxy?
- 1: Yes
- 2: No
Proxy interview (GR) - Question identifier:GR_N03
Record the reason why this component is being completed by proxy. Proxy interviews for respondents aged 6 and older are to occur only if the mental or physical health of the selected member makes it impossible to complete the interview during the collection period. If the reason for the proxy interview is neither of these choices, please press <F10> to exit the application and assign an appropriate outcome code.
- 1: Physical health condition
- 2: Mental health condition
Proxy interview (GR) - Question identifier:GR_N04
Enter the condition.
Long Answer Length = 80
Nutritional Supplements (First recall) (NSP)
Nutritional Supplements (First recall) (NSP) - Question identifier:NSP_R01
Many people use nutritional supplements such as vitamins, minerals, fibre supplements, antacids, fish oils and other oils to improve their diet. The next questions will deal with any supplements that you may have taken recently.
Nutritional Supplements (First recall) (NSP) - Question identifier:NSP_Q01
In the past month, that is, from ^ONEMONTHAGO to yesterday, did you take any vitamins, minerals, fibre supplements, antacids, fish oils or other oils?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Nutritional Supplements (First recall) (NSP) - Question identifier:NSP_Q02
In the past month, how many different vitamins, minerals, fibre supplements, antacids, fish oils or other oils did you take?
Min = 1; Max = 40
Nutritional Supplements (First recall) (NSP) - Question identifier:NSP_Q03
I would like to record the details of those nutritional supplements to add to your food intake. Do you have the bottle(s), tube(s) or box(es) available?
- 1: Yes
- 2: No
Nutritional Supplements Detail (NSD)
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q1A
Is a Natural Product Number (NPN) available for [this/the first/the next] product?
- 1: Yes
- 2: No
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q1B
What is the NPN (Natural Product Number) of [this/the first/the next] nutritional supplement?
Long Answer Length = 8
Nutritional Supplements Detail (NSD) - Question identifier:NSD_N2
Supplement name for NPN [Answer at NSD_Q1B] is [Answer in lookup table]. Please confirm.
- 1: Yes
- 2: No
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q2A
What is the name of [this/the first/the next] product?
Long Answer Length = 100
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q2C
What is the concentration (strength) of the main ingredient(s)?
Long Answer Length = 100
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q3
In the past month, on how many days did you take this supplement?
Min = 1; Max = 30
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q5
On the days that you took this supplement, how much did you usually take?
Min = 0.1; Max = 40.0
Nutritional Supplements Detail (NSD) - Question identifier:NSD_N6
Select reporting unit.
- 01: Tablets
- 02: Capsules
- 03: Pills, caplets, softgels, gelcaps, vegicaps, chewable tablets
- 04: Droppers
- 05: Teaspoons
- 06: Tablespoons
- 07: Drops
- 08: Injections/shots
- 09: Lozenges/Cough drops
- 10: Millilitres
- 11: Wafers
- 12: Cans
- 13: Grams
- 14: Dots
- 15: Cups
- 16: Sprays/Squirts
- 17: Chews/Gummies
- 18: Scoops
- 19: Capfuls
- 20: Ounces
- 21: Packages/Packets
- 22: Vials
- 23: Gumballs
- 91: Other - Specify
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q7
Was that a liquid or a powder?
- 1: Liquid
- 2: Powder
- 8: RF
- 9: DK
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q8
[During the last interview it was reported that you took ^SUPPNAME.]. Did you take this supplement yesterday?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q9
How much of this supplement did you take yesterday?
Min = 0.1; Max = 40.0
Nutritional Supplements Detail (NSD) - Question identifier:NSD_N9A
Select the reporting unit.
- 01: Tablets
- 02: Capsules
- 03: Pills, caplets, softgels, gelcaps, vegicaps, chewable tablets
- 04: Droppers
- 05: Teaspoons
- 06: Tablespoons
- 07: Drops
- 08: Injections/shots
- 09: Lozenges/Cough drops
- 10: Millilitres
- 11: Wafers
- 12: Cans
- 13: Grams
- 14: Dots
- 15: Cups
- 16: Sprays/Squirts
- 17: Chews/Gummies
- 18: Scoops
- 19: Capfuls
- 20: Ounces
- 21: Packages/Packets
- 22: Vials
- 23: Gumballs
- 91: Other - Specify
- 98: RF
- 99: DK
Nutritional Supplements Detail (NSD) - Question identifier:NSD_Q10
Was that a liquid or a powder?
- 1: Liquid
- 2: Powder
- 8: RF
- 9: DK
General Health (GEN)
Health Minimum Block (HM)
Health Minimum Block (HM) - Question identifier:HM_R01
The next question is about your health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.
Health Minimum Block (HM) - Question identifier:HM_Q01
In general, would you say your health is... ?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
- 8: RF
- 9: DK
Measured Height and Weight (MHW)
Measured Height and Weight (MHW) - Question identifier:MHW_N1A
Is respondent available to have measurements taken?
- 1: Yes
- 2: No
Measured Height and Weight (MHW) - Question identifier:MHW_N1B
Are there any reasons that make it impossible to measure the respondent's weight?
- 1: Yes
- 2: No
Measured Height and Weight (MHW) - Question identifier:MHW_N1C
Select reasons why it is impossible to measure the respondent's weight.
- 01: Unable to stand unassisted
- 02: In a wheel chair
- 03: Bedridden
- 04: Telephone interview
- 05: Interview setting (e.g., interview outdoors or in a public place)
- 06: Safety concerns
- 07: Has already refused to have weight measured
- 08: Equipment (e.g., unavailable or not working)
- 09: Respondent too heavy
- 10: Other - Specify
Measured Height and Weight (MHW) - Question identifier:MHW_R2
Health and nutritional requirements are affected by a person's size. Because of this, I would like to measure your weight and height. The measurements taken will not require any touching.
Measured Height and Weight (MHW) - Question identifier:MHW_Q2A
Do I have your permission to weigh you?
- 1: Yes
- 2: No
Measured Height and Weight (MHW) - Question identifier:MHW_N2B
Record weight to the nearest 0.01 kg. If the scale does not work, or if for some other reason you cannot weigh the respondent, enter DK.
Min = 1.00; Max = 150
Measured Height and Weight (MHW) - Question identifier:MHW_N3A
Were there any articles of clothing or physical characteristics which affected the accuracy of this measurement?
- 1: Yes
- 2: No
Measured Height and Weight (MHW) - Question identifier:MHW_N3B
Select reasons affecting accuracy.
- 1: Shoes or boots
- 2: Heavy sweater or jacket
- 3: Jewellery
- 4: Other - Specify
Measured Height and Weight (MHW) - Question identifier:MHW_N4
Select the reason for not weighing the respondent.
- 1: Scale not functioning properly
- 2: Respondent too heavy
- 3: Other - Specify
Measured Height and Weight (MHW) - Question identifier:MHW_N5A
Are there any reasons that make it impossible to measure the respondent's height?
- 1: Yes
- 2: No
Measured Height and Weight (MHW) - Question identifier:MHW_N5B
Select reasons why it is impossible to measure the respondent's height.
- 1: Too tall
- 2: Interview setting (e.g., interview outdoors or in a public place)
- 3: Safety concerns
- 4: Has already refused to have height measured
- 5: Other - Specify
Measured Height and Weight (MHW) - Question identifier:MHW_R6
Health and nutritional requirements are affected by a person's size. Because of this, I would like to measure your height. The measurement will not require any touching.
Measured Height and Weight (MHW) - Question identifier:MHW_Q6A
Do I have your permission to measure your height?
- 1: Yes
- 2: No
Measured Height and Weight (MHW) - Question identifier:MHW_N6B
Enter height to nearest 0.5 cm.
Min = 30.0; Max = 250.0
Measured Height and Weight (MHW) - Question identifier:MHW_N7A
Were there any articles of clothing or physical characteristics which affected the accuracy of this measurement?
- 1: Yes
- 2: No
Measured Height and Weight (MHW) - Question identifier:MHW_N7B
Select reasons affecting accuracy.
- 1: Shoes or boots
- 2: Hairstyle
- 3: Hat
- 4: Other - Specify
Self-reported Height and Weight (HWT)
Self-reported Height and Weight (HWT) - Question identifier:HWT_R01
To understand health, it is important to know the size of a person. Because of this I would like to ask your ["height"/"weight"/"height and weight"].
Self-reported Height and Weight (HWT) - Question identifier:HWT_Q01
Are you willing to tell me your ["height"/"weight"/"height and weight"]?
- 1: Yes
- 2: No
Self-reported Height and Weight (HWT) - Question identifier:HWT_Q02
How tall are you without shoes on?
- 0: Less than 1' / 12" (less than 29.2 cm.)
- 1: 1'0" to 1'11" / 12" to 23" (29.2 to 59.6 cm.)
- 2: 2'0" to 2'11" / 24" to 35" (59.7 to 90.1 cm.)
- 3: 3'0" to 3'11" / 36" to 47" (90.2 to 120.6 cm.)
- 4: 4'0" to 4'11" / 48" to 59" (120.7 to 151.0 cm.)
- 5: 5'0" to 5'11" (151.1 to 181.5 cm.)
- 6: 6'0" to 6'11" (181.6 to 212.0 cm.)
- 7: 7'0" and over (212.1 cm. and over)
- 8: RF
- 9: DK
Self-reported Height and Weight (HWT) - Question identifier:HWT_N02A
Select the exact height.
- 00: 1'0" / 12" (29.2 to 31.7 cm.)
- 01: 1'1" / 13" (31.8 to 34.2 cm.)
- 02: 1'2" / 14" (34.3 to 36.7 cm.)
- 03: 1'3" / 15" (36.8 to 39.3 cm.)
- 04: 1'4" / 16" (39.4 to 41.8 cm.)
- 05: 1'5" / 17" (41.9 to 44.4 cm.)
- 06: 1'6" / 18" (44.5 to 46.9 cm.)
- 07: 1'7" / 19" (47.0 to 49.4 cm.)
- 08: 1'8" / 20" (49.5 to 52.0 cm.)
- 09: 1'9" / 21" (52.1 to 54.5 cm.)
- 10: 1'10" / 22" (54.6 to 57.1 cm.)
- 11: 1'11" / 23" (57.2 to 59.6 cm.)
- 98: RF
- 99: DK
Self-reported Height and Weight (HWT) - Question identifier:HWT_N02B
Select the exact height.
- 00: 2'0" / 24" (59.7 to 62.1 cm.)
- 01: 2'1" / 25" (62.2 to 64.7 cm.)
- 02: 2'2" / 26" (64.8 to 67.2 cm.)
- 03: 2'3" / 27" (67.3 to 69.8 cm.)
- 04: 2'4" / 28" (69.9 to 72.3 cm.)
- 05: 2'5" / 29" (72.4 to 74.8 cm.)
- 06: 2'6" / 30" (74.9 to 77.4 cm.)
- 07: 2'7" / 31" (77.5 to 79.9 cm.)
- 08: 2'8" / 32" (80.0 to 82.5 cm.)
- 09: 2'9" / 33" (82.6 to 85.0 cm.)
- 10: 2'10" / 34" (85.1 to 87.5 cm.)
- 11: 2'11" / 35" (87.6 to 90.1 cm.)
- 98: RF
- 99: DK
Self-reported Height and Weight (HWT) - Question identifier:HWT_N02C
Select the exact height.
- 00: 3'0" / 36" (90.2 to 92.6 cm.)
- 01: 3'1" / 37" (92.7 to 95.2 cm.)
- 02: 3'2" / 38" (95.3 to 97.7 cm.)
- 03: 3'3" / 39" (97.8 to 100.2 cm.)
- 04: 3'4" / 40" (100.3 to 102.8 cm.)
- 05: 3'5" / 41" (102.9 to 105.3 cm.)
- 06: 3'6" / 42" (105.4 to 107.9 cm.)
- 07: 3'7" / 43" (108.0 to 110.4 cm.)
- 08: 3'8" / 44" (110.5 to 112.9 cm.)
- 09: 3'9" / 45" (113.0 to 115.5 cm.)
- 10: 3'10" / 46" (115.6 to 118.0 cm.)
- 11: 3'11" / 47" (118.1 to 120.6 cm.)
- 98: RF
- 99: DK
Self-reported Height and Weight (HWT) - Question identifier:HWT_N02D
Select the exact height.
- 00: 4'0" / 48" (120.7 to 123.1 cm.)
- 01: 4'1" / 49" (123.2 to 125.6 cm.)
- 02: 4'2" / 50" (125.7 to 128.2 cm.)
- 03: 4'3" / 51" (128.3 to 130.7 cm.)
- 04: 4'4" / 52" (130.8 to 133.3 cm.)
- 05: 4'5" / 53" (133.4 to 135.8 cm.)
- 06: 4'6" / 54" (135.9 to 138.3 cm.)
- 07: 4'7" / 55" (138.4 to 140.9 cm.)
- 08: 4'8" / 56" (141.0 to 143.4 cm.)
- 09: 4'9" / 57" (143.5 to 146.0 cm.)
- 10: 4'10" / 58" (146.1 to 148.5 cm.)
- 11: 4'11" / 59" (148.6 to 151.0 cm.)
- 98: RF
- 99: DK
Self-reported Height and Weight (HWT) - Question identifier:HWT_N02E
Select the exact height.
- 00: 5'0" (151.1 to 153.6 cm.)
- 01: 5'1" (153.7 to 156.1 cm.)
- 02: 5'2" (156.2 to 158.7 cm.)
- 03: 5'3" (158.8 to 161.2 cm.)
- 04: 5'4" (161.3 to 163.7 cm.)
- 05: 5'5" (163.8 to 166.3 cm.)
- 06: 5'6" (166.4 to 168.8 cm.)
- 07: 5'7" (168.9 to 171.4 cm.)
- 08: 5'8" (171.5 to 173.9 cm.)
- 09: 5'9" (174.0 to 176.4 cm.)
- 10: 5'10" (176.5 to 179.0 cm.)
- 11: 5'11" (179.1 to 181.5 cm.)
- 98: RF
- 99: DK
Self-reported Height and Weight (HWT) - Question identifier:HWT_N02F
Select the exact height.
- 00: 6'0" (181.6 to 184.1 cm.)
- 01: 6'1" (184.2 to 186.6 cm.)
- 02: 6'2" (186.7 to 189.1 cm.)
- 03: 6'3" (189.2 to 191.7 cm.)
- 04: 6'4" (191.8 to 194.2 cm.)
- 05: 6'5" (194.3 to 196.8 cm.)
- 06: 6'6" (196.9 to 199.3 cm.)
- 07: 6'7" (199.4 to 201.8 cm.)
- 08: 6'8" (201.9 to 204.4 cm.)
- 09: 6'9" (204.5 to 206.9 cm.)
- 10: 6'10" (207.0 to 209.5 cm.)
- 11: 6'11" (209.6 to 212.0 cm.)
- 98: RF
- 99: DK
Self-reported Height and Weight (HWT) - Question identifier:HWT_Q03
How much do you weigh?
Min = 1; Max = 575
Self-reported Height and Weight (HWT) - Question identifier:HWT_N04
Was that in pounds or kilograms?
- 1: Pounds
- 2: Kilograms
Physical Activity - Short Form (PHS)
Physical Activity - Short Form (PHS) - Question identifier:PHS_R01
The next questions are about physical activity done for leisure, work, housework, or for transportation.
Physical Activity - Short Form (PHS) - Question identifier:PHS_Q01
In the past 7 days, how many times did you participate in moderate or vigorous physical activity?
Min = 0; Max = 42
Physical Activity - Short Form (PHS) - Question identifier:PHS_Q02
About how much time did you spend on each occasion?
- 1: 0 to 15 minutes
- 2: 16 to 30 minutes
- 3: 31 to 60 minutes
- 4: 61 minutes to 2 hours
- 5: More than 2 hours
- 8: RF
- 9: DK
Physical Activity of Children and Youth (CPA)
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_R01A
The next questions are about your physical activity. Physical activity is any activity that increases the heart rate and causes someone to be out of breath some of the time. Physical activity can take place while playing sports, doing school activities, [playing with friends/working or helping family with chores], or walking to school.
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_R01B
Some examples of physical activity are running, brisk walking, dancing, swimming, rollerblading, skateboarding, biking, soccer, basketball and football.
For these next two questions, add up all the time you spend in physical activity each day.
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q01
Over the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?
Min = 0; Max = 7
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q02
Over a typical or usual week, on how many days are you physically active for a total of at least 60 minutes per day?
Min = 0; Max = 7
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q03
About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:
... in your free time at school, for example, at lunch?
- 1: Never
- 2: Less than 2 hours per week
- 3: 2 to less than 4 hours per week
- 4: 4 to less than 7 hours per week
- 5: 7 or more hours per week
- 8: RF
- 9: DK
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q04
(About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:)
... in your class time at school?
- 1: Never
- 2: Less than 2 hours per week
- 3: 2 to less than 4 hours per week
- 4: 4 to less than 7 hours per week
- 5: 7 or more hours per week
- 8: RF
- 9: DK
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q05
About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:
... outside of school while participating in lessons or league or team sports?
- 1: Never
- 2: Less than 2 hours per week
- 3: 2 to less than 4 hours per week
- 4: 4 to less than 7 hours per week
- 5: 7 or more hours per week
- 8: RF
- 9: DK
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q06
(About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:)
... outside of school while participating in unorganized activities, either on your own or with friends?
- 1: Never
- 2: Less than 2 hours per week
- 3: 2 to less than 4 hours per week
- 4: 4 to less than 7 hours per week
- 5: 7 or more hours per week
- 8: RF
- 9: DK
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q07
(About how many hours a week do you usually take part in physical activity that makes you out of breath or warmer than usual:)
... outside of school while doing paid or unpaid work or while helping family with chores?
- 1: Never
- 2: Less than 2 hours per week
- 3: 2 to less than 4 hours per week
- 4: 4 to less than 7 hours per week
- 5: 7 or more hours per week
- 8: RF
- 9: DK
Physical Activity of Children and Youth (CPA) - Question identifier:CPA_Q08
On average, about how many hours a day do you spend watching TV, using a game console, computer, tablet or hand-held electronic device? Include time spent playing games, watching videos or movies, doing homework, e-mailing, chatting and surfing the Internet.
Min = 0; Max = 24
Women's Health (WHC)
Women's Health (WHC) - Question identifier:WHC_R01
Girls and women have different nutritional needs at different points in their lives, such as when pregnant or after menopause. For that reason, I need to ask some questions about women's health.
Women's Health (WHC) - Question identifier:WHC_Q01
Have you begun having menstrual cycles (periods) yet?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Women's Health (WHC) - Question identifier:WHC_Q02
At what age did you have your first period?
Min = 0; Max = 30
Women's Health (WHC) - Question identifier:WHC_Q03
Are you currently pregnant?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Women's Health (WHC) - Question identifier:WHC_Q04
Have you given birth in the past 5 years?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Women's Health (WHC) - Question identifier:WHC_Q05
Are you you currently breastfeeding?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Women's Health (WHC) - Question identifier:WHC_Q06
Have your periods stopped?
- 1: Yes
- 2: No
- 3: Not sure, cycle irregular
- 8: RF
- 9: DK
Women's Health (WHC) - Question identifier:WHC_Q08
In the past month, did you take birth control pills, including for reasons other than birth control?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic Conditions (CCC)
Chronic Conditions (CCC) - Question identifier:CCC_R01
Now I'd like to ask about certain long-term health conditions which you may have. We are interested in "long-term conditions" which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.
Chronic Conditions (CCC) - Question identifier:CCC_Q071
Do you have high blood pressure?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic Conditions (CCC) - Question identifier:CCC_Q101
Do you have diabetes?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic Conditions (CCC) - Question identifier:CCC_Q102
How old were you when this was first diagnosed?
Min = 1; Max = 121
Chronic Conditions (CCC) - Question identifier:CCC_Q121
Do you have heart disease?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic Conditions (CCC) - Question identifier:CCC_Q131
Do you have cancer?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Chronic Conditions (CCC) - Question identifier:CCC_Q401
Do you have osteoporosis?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Smoking (SMK)
Smoking (SMK) - Question identifier:SMK_R01
The next questions are about smoking.
Smoking (SMK) - Question identifier:SMK_Q01
In your lifetime, have you smoked a total of 100 or more cigarettes (about 4 packs)?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Smoking (SMK) - Question identifier:SMK_Q02
At the present time, do you smoke cigarettes daily, occasionally or not at all?
- 1: Daily
- 2: Occasionally
- 3: Not at all
- 8: RF
- 9: DK
Socio-Demographic Characteristics (SDC)
Socio-Demographic Characteristics (SDC) - Question identifier:SDC_R01
Now some general background questions which will help us compare the health of people in Canada.
Socio-Demographic Characteristics (SDC) - Question identifier:SDC_Q01
In what country were you born?
- 1: Search
- 2: Other - Specify
- 8: RF
- 9: DK
Socio-Demographic Characteristics (SDC) - Question identifier:SDC_Q02
Are you now, or have you ever been a landed immigrant in Canada?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Socio-Demographic Characteristics (SDC) - Question identifier:SDC_Q03
In what year did you first become a landed immigrant in Canada?
Min = 1870; Max = 2100
Aboriginal Minimum (AMB)
Aboriginal Minimum (AMB) - Question identifier:AMB_Q01
Are you an Aboriginal person, that is, First Nations, Métis or Inuk (Inuit)? First Nations includes Status and Non-Status Indians.
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Aboriginal Minimum (AMB) - Question identifier:AMB_Q02
Are you First Nations, Métis or Inuk (Inuit)?
- 1: First Nations (North American Indian)
- 2: Métis
- 3: Inuk (Inuit)
- 8: RF
- 9: DK
Population group (PG)
Population group (PG) - Question identifier:PG_Q01
You may belong to one or more racial or cultural groups on the following list.
Are you... ?
- 01: White
- 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
- 03: Chinese
- 04: Black
- 05: Filipino
- 06: Latin American
- 07: Arab
- 08: Southeast Asian (e.g., Vietnamese, Cambodian,
Malaysian, Laotian) - 09: West Asian (e.g., Iranian, Afghan)
- 10: Korean
- 11: Japanese
- 12: Other - Specify
- 98: RF
- 99: DK
Language Minimum (LAN)
Language Minimum (LAN) - Question identifier:LAN_Q01
Of English or French, which language(s) do you speak well enough to conduct a conversation? Is it... ?
- 1: English only
- 2: French only
- 3: Both English and French
- 4: Neither English nor French
- 8: RF
- 9: DK
Language Look-up (LLU)
Language Look-up (LLU) - Question identifier:LLU_Q01
What language do you speak most often at home? / What is the language that you first learned at home in childhood and still understand?
Selection of Second Recall Respondent (SEL2)
Education (EDU)
Education (EDU) - Question identifier:EDU_R01
The following questions are about education.
HC: Education Sublock School attendance "currently" - ESC1
HC: Education Sublock School attendance "currently" - ESC1 - Question identifier:ESC1_Q01
Are you currently attending school, college, CEGEP or university?
- 1: Yes
- 2: No
- 9: Don't know
- 8: Refusal
HC: Education minimum - EDM
HC: Education minimum - EDM - Question identifier:EDM_Q01
What type of educational institution [are you attending / did you attend]?
- 1: Elementary, junior high school or high school
- 2: Trade school, college, CEGEP, or other non-university institution
- 3: University
- 9: Don't know
- 5: Refusal
HC: Education minimum - EDM - Question identifier:EDM_Q02
Were you enrolled as... ?
- 1: A full-time student
- 2: A part-time student
- 3: Both full-time and part-time student
- 9: Don't know
- 8: Refusal
Labour Market Activities Minimal (LMAM)
Labour Market Activities Minimal (LMAM) - Question identifier:LMAM_Q01
Many of the following questions concern your activities last week. By last week, I mean the week beginning on ^REFBEGE, and ending yesterday.
Last week, did you work at a job or business?
(regardless of the number of hours)
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Labour Market Activities Minimal (LMAM) - Question identifier:LMAM_Q02
Last week, did you have a job or business from which you were absent?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Labour Market Activities Minimal (LMAM) - Question identifier:LMAM_Q03
What was the main reason you were absent from work last week?
- 01: Own illness or disability
- 02: Caring for own children
- 03: Caring for elder relative (60 years of age or older)
- 04: Maternity or parental leave
- 05: Other personal or family responsibilities
- 06: Vacation
- 07: Labour dispute (strike or lockout) (Employees only)
- 08: Temporary layoff due to business conditions (Employees only)
- 09: Seasonal layoff (Employees only)
- 10: Casual job, no work available (Employees only)
- 11: Work schedule (e.g., shift work) (Employees only)
- 12: Self-employed, no work available (Self-employed only)
- 13: Seasonal business (Excluding employees)
- 14: Other - Specify
- 98: RF
- 99: DK
Person most knowledgeable about household situation (PMK)
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q014
[Statistics Canada, your provincial ministry of health and the "Institut de la statistique du Québec"/Statistics Canada and your provincial ministry of health] may combine your responses from this survey with information from other surveys or from administrative data sources.
- 1: Continue
- 2: Respondent does not want his/her responses combined with other sources
- 3: Other [e.g., respondent hung up, interview suspended/interrupted]
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q015A
Having a provincial (or territorial) health number will assist us in linking to this other information.
Do you have [an/a] [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/Northwest Territories/Nunavut] health number?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q015B
For which province (or territory) is your health number?
- 10: Newfoundland and Labrador
- 11: Prince Edward Island
- 12: Nova Scotia
- 13: New Brunswick
- 24: Quebec
- 35: Ontario
- 46: Manitoba
- 47: Saskatchewan
- 48: Alberta
- 59: British Columbia
- 60: Yukon
- 61: Northwest Territories
- 62: Nunavut
- 88: Does not have a Canadian health number
- 98: RF
- 99: DK
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R016A
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R016B
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial ministries of health, the "Institut de la statistique du Québec", Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
The "Institut de la statistique du Québec" and provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q016
These organizations have agreed to keep your information confidential and use it only for statistical purposes.
Do you agree to share the information provided?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q017
As part of this survey, you have been selected to participate in a brief follow up interview. This will take place in the next 3 to 10 days and will be conducted over the telephone. Can we schedule an appointment?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_N17
Press <Shift + F11> to set an appointment with respondent. If the reference period was a weekday please try to schedule an appointment with a reference period being a weekend day and vice versa.
Press <1> to continue.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_N18
Leave a Respondent Food Model Booklet and note the date and time of appointment, and the interviewer's name on the cover page.
Press <1> to continue.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R020
For the last few questions, I would like to speak with someone who would be best able to answer questions [about the entire household such as household income and food purchases/on sharing and linking of data].
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q020
Who would this person be?
- 01: MEMBER1
- 02: MEMBER2
- 03: MEMBER3
- 04: MEMBER4
- 05: MEMBER5
- 06: MEMBER6
- 07: MEMBER7
- 08: MEMBER8
- 09: MEMBER9
- 10: MEMBER10
- 11: MEMBER11
- 12: MEMBER12
- 13: MEMBER13
- 14: MEMBER14
- 15: MEMBER15
- 16: MEMBER16
- 17: MEMBER17
- 18: MEMBER18
- 19: MEMBER19
- 20: MEMBER20
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_Q030B
Is [MEMBER1/MEMBER2/MEMBER3/MEMBER4/MEMBER5/MEMBER6/MEMBER7/MEMBER8/MEMBER9/MEMBER10/MEMBER11/MEMBER12/MEMBER13/MEMBER14/MEMBER15/MEMBER16/MEMBER17/MEMBER18/MEMBER19/MEMBER20] available?
- 1: Yes
- 2: No
- 3: Person most knowledgeable about household refuses to participate
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R042
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R045
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to know the best time to speak with [MEMBER1/MEMBER2/MEMBER3/MEMBER4/MEMBER5/MEMBER6/MEMBER7/MEMBER8/MEMBER9/MEMBER10/MEMBER11/MEMBER12/MEMBER13/MEMBER14/MEMBER15/MEMBER16/MEMBER17/MEMBER18/MEMBER19/MEMBER20].
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R050
This completes your portion of the interview. On behalf of Statistics Canada, I would like to thank you very much for your time. I would now like to speak with ^MEMBERNAME.
Person most knowledgeable about household situation (PMK) - Question identifier:PMK_R060
Hello, My name is... I've just completed the main portion of the interview with ^FNAME. At this point I need to finish the interview with a few [general questions on your household's situation/questions on sharing and linking of data]. ^FNAME said you would be the best person to answer these types of questions.
Food Security (FSC)
Food Security (FSC) - Question identifier:FSC_R020
The following questions are about the food situation for your household in the past 12 months. I'm going to read you several statements that may be used to describe the food situation for a household. Please tell me if the statement was often true, sometimes true, or never true for [you/you and other household members] in the past 12 months.
Food Security (FSC) - Question identifier:FSC_Q020
The first statement is: [You/You and other household members] worried that food would run out before you got money to buy more. Was that often true, sometimes true, or never true in the past 12 months?
- 1: Often true
- 2: Sometimes true
- 3: Never true
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q030
The food that [you/you and other household members] bought just didn't last, and there wasn't any money to get more. Was that often true, sometimes true, or never true in the past 12 months?
- 1: Often true
- 2: Sometimes true
- 3: Never true
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q040
[You/You and other household members] couldn't afford to eat balanced meals. In the past 12 months was that often true, sometimes true, or never true?
- 1: Often true
- 2: Sometimes true
- 3: Never true
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_R050
Now I'm going to read a few statements that may describe the food situation for households with children.
Food Security (FSC) - Question identifier:FSC_Q050
[You/You or other adults in your household] relied on only a few kinds of low-cost food to feed [^CHILDFNAME/the children] because you were running out of money to buy food. Was that often true, sometimes true, or never true in the past 12 months?
- 1: Often true
- 2: Sometimes true
- 3: Never true
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q060
[You/You or other adults in your household] couldn't feed [^CHILDFNAME/the children] a balanced meal, because you couldn't afford it. Was that often true, sometimes true, or never true in the past 12 months?
- 1: Often true
- 2: Sometimes true
- 3: Never true
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q070
[^CHILDFNAME was/The children were] not eating enough because [you/you or other adults in your household] just couldn't afford enough food. Was that often, sometimes, or never true in the past 12 months?
- 1: Often true
- 2: Sometimes true
- 3: Never true
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_R080
The following few questions are about the food situation in the past 12 months for you or any other adults in your household.
Food Security (FSC) - Question identifier:FSC_Q080
In the past 12 months, since last ^CURRENTMONTH, did [you/you or other adults in your household] ever cut the size of your meals or skip meals because there wasn't enough money for food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q081
How often did this happen? Almost every month, some months but not every month, or in only 1 or 2 months?
- 1: Almost every month
- 2: Some months but not every month
- 3: Only 1 or 2 months
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q090
In the past 12 months, did you (personally) ever eat less than you felt you should because there wasn't enough money to buy food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q100
In the past 12 months, were you (personally) ever hungry but didn't eat because you couldn't afford enough food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q110
In the past 12 months, did you (personally) ever lose weight because you didn't have enough money for food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q120
In the past 12 months, did [you/you or other adults in your household] ever not eat for a whole day because there wasn't enough money for food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q121
How often did this happen? Almost every month, some months but not every month, or in only 1 or 2 months?
- 1: Almost every month
- 2: Some months but not every month
- 3: Only 1 or 2 months
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_R130
Now, a few questions on the food experiences for children in your household.
Food Security (FSC) - Question identifier:FSC_Q130
In the past 12 months, did [you/you or other adults in your household] ever cut the size of [^CHILDFNAME 's/any of the children's] meals because there wasn't enough money for food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q140
In the past 12 months, did [^CHILDFNAME/any of the children] ever skip meals because there wasn't enough money for food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q141
How often did this happen? Almost every month, some months but not every month, or in only 1 or 2 months?
- 1: Almost every month
- 2: Some months but not every month
- 3: Only 1 or 2 months
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q150
In the past 12 months, [was ^CHILDFNAME/were any of the children] ever hungry but you just couldn't afford more food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Food Security (FSC) - Question identifier:FSC_Q160
In the past 12 months, did [^CHILDFNAME/any of the children] ever not eat for a whole day because there wasn't enough money for food?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Income (INC)
Income (INC) - Question identifier:INC_R01
There is a relationship between nutrition and income. Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.
Income (INC) - Question identifier:INC_Q01
Thinking about the total income for all household members, from which of the following sources did your household receive any income in the past 12 months?
- 01: Wages and salaries
- 02: Income from self-employment
- 03: Dividends and interest (e.g., on bonds, savings)
- 04: Employment insurance
- 05: Worker's compensation
- 06: Benefits from Canada or Quebec Pension Plan
- 07: Job related retirement pensions, superannuation and annuities
- 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
- 09: Old Age Security and Guaranteed Income Supplement
- 10: Provincial or municipal social assistance or welfare
- 11: Child Tax Benefit or family allowances
- 12: Child support
- 13: Alimony
- 14: Other (e.g., rental income, scholarships)
- 15: None
- 98: RF
- 99: DK
Income (INC) - Question identifier:INC_Q02
Does this amount include a supplement for people with disabilities?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q03
What was the main source of income?
- 01: Wages and salaries
- 02: Income from self-employment
- 03: Dividends and interest (e.g., on bonds, savings)
- 04: Employment insurance
- 05: Worker's compensation
- 06: Benefits from Canada or Quebec Pension Plan
- 07: Job related retirement pensions, superannuation and annuities
- 08: RRSP/RRIF (Registered Retirement Savings Plan/Registered Retirement Income Fund)
- 09: Old Age Security and Guaranteed Income Supplement
- 10: Provincial or municipal social assistance or welfare
- 11: Child Tax Benefit or family allowances
- 12: Child support
- 13: Alimony
- 14: Other (e.g., rental income, scholarships)
- 15: None
- 98: RF
- 99: DK
Income (INC) - Question identifier:INC_Q04
What is your best estimate of the total household income received by all household members, from all sources, before taxes and deductions, in the past 12 months?
Min = -9000000; Max = 90000000
Income (INC) - Question identifier:INC_Q06A
Can you estimate in which of the following groups your household income falls? Was the total household income in the past 12 months...?
- 1: Less than $50,000, including income loss
- 2: $50,000 and more
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q06B
Please stop me when I have read the category which applies to your household. Was it...?
- 1: Less than $5,000
- 2: $5,000 to less than $10,000
- 3: $10,000 to less than $15,000
- 4: $15,000 to less than $20,000
- 5: $20,000 to less than $30,000
- 6: $30,000 to less than $40,000
- 7: $40,000 to less than $50,000
- 8: RF
- 9: DK
Income (INC) - Question identifier:INC_Q06C
Please stop me when I have read the category which applies to your household. Was it...?
- 1: $50,000 to less than $60,000
- 2: $60,000 to less than $70,000
- 3: $70,000 to less than $80,000
- 4: $80,000 to less than $90,000
- 5: $90,000 to less than $100,000
- 6: $100,000 to less than $150,000
- 7: $150,000 and over
- 8: RF
- 9: DK
Administration (ADM)
Administration (ADM) - Question identifier:ADM_Q01
[Statistics Canada, your provincial ministry of health and the "Institut de la statistique du Québec"/Statistics Canada and your provincial ministry of health] may combine your responses from this survey with information from other surveys or from administrative data sources.
- 1: Continue
- 2: Respondent does not want his/her responses combined with other sources
- 3: Other [e.g. respondent hung up, interview suspended/interrupted]
Administration (ADM) - Question identifier:ADM_Q03A
Having a provincial (or territorial) health number will assist us in linking to this other information.
Do you have [an/a] [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/Northwest Territories/Nunavut] health number?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration (ADM) - Question identifier:ADM_Q03B
For which province (or territory) is your health number?
- 10: Newfoundland and Labrador
- 11: Prince Edward Island
- 12: Nova Scotia
- 13: New Brunswick
- 24: Quebec
- 35: Ontario
- 46: Manitoba
- 47: Saskatchewan
- 48: Alberta
- 59: British Columbia
- 60: Yukon
- 61: Northwest Territories
- 62: Nunavut
- 88: Does not have a Canadian health number
- 98: RF
- 99: DK
Administration (ADM) - Question identifier:ADM_R04A
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial ministries of health, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.
Administration (ADM) - Question identifier:ADM_R04B
To avoid duplication of surveys, Statistics Canada has signed agreements with provincial ministries of health, the Institut de la statistique du Québec, Health Canada and the Public Health Agency of Canada to share the information that you provided on this survey.
The Institut de la statistique du Québec and provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses or telephone numbers will be provided.
Administration (ADM) - Question identifier:ADM_Q04
These organizations have agreed to keep your information confidential and use it only for statistical purposes.
Do you agree to share the information provided?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration (ADM) - Question identifier:ADM_N05
Is this a fictitious name for the respondent?
- 1: Yes
- 2: No
- 9: DK
Administration (ADM) - Question identifier:ADM_N06
Remind respondent about the importance of getting correct names.
Do you want to make corrections to:
- 1: ... first name only?
- 2: ... last name only?
- 3: ... both names?
- 4: ... no corrections?
Administration (ADM) - Question identifier:ADM_N07
Enter the first name only.
Long Answer Length = 25
Administration (ADM) - Question identifier:ADM_N08
Enter the last name only.
Long Answer Length = 25
Administration (ADM) - Question identifier:ADM_N09
Was this interview conducted on the telephone or in person?
- 1: On telephone
- 2: In person
- 3: Both
Administration (ADM) - Question identifier:ADM_N10
Was the respondent alone when you asked this health questionnaire?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration (ADM) - Question identifier:ADM_N11
Do you think that the answers of the respondent were affected by someone else being there?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration (ADM) - Question identifier:ADM_N12
Record language of interview.
- 01: English
- 02: French
- 03: Chinese
- 04: Italian
- 05: Punjabi
- 06: Spanish
- 07: Portuguese
- 08: Polish
- 09: German
- 10: Vietnamese
- 11: Arabic
- 12: Tagalog (Filipino)
- 13: Greek
- 14: Tamil
- 15: Cree
- 16: Afghan
- 17: Cantonese
- 18: Hindi
- 19: Mandarin
- 20: Persian
- 21: Russian
- 22: Ukrainian
- 23: Urdu
- 24: Inuktitut
- 90: Other - Specify
- 98: RF
- 99: DK
Administration (ADM) - Question identifier:ADM_N13
Was the child present and able to participate during most of the interview?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration (ADM) - Question identifier:ADM_Q17
As part of this survey, you have been selected to participate in a brief follow up interview. This will take place in the next 3 to 10 days and will be conducted over the telephone. Can we schedule an appointment?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Administration (ADM) - Question identifier:ADM_N18
Press <Shift + F11> to set an appointment with respondent. If the reference period was a weekday please try to schedule an appointment with a reference period being a weekend day and vice versa. When finished, press <1> to continue.
Administration (ADM) - Question identifier:ADM_N19
Leave a Respondent Food Model Booklet and note the date and time of appointment, and the interviewer's name on the cover page.
Press <1> to continue.
Health Number Validation (HN)
Health Number Validation (HN) - Question identifier:HN_Q01
What is your health number?
Long Answer Length = 12
Health Number Validation (HN) - Question identifier:HN_N01A
Re-enter the health number.
Long Answer Length = 12
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